Provider Demographics
NPI:1336572031
Name:AUGUST J. DURSO, JR. DDS, LTD.
Entity Type:Organization
Organization Name:AUGUST J. DURSO, JR. DDS, LTD.
Other - Org Name:DR. DURSO & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUST
Authorized Official - Middle Name:
Authorized Official - Last Name:DURSO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-635-0117
Mailing Address - Street 1:1661 FEEHANVILLE DR.
Mailing Address - Street 2:STE 420
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-6045
Mailing Address - Country:US
Mailing Address - Phone:847-635-0117
Mailing Address - Fax:847-635-8562
Practice Address - Street 1:1661 FEEHANVILLE DR.
Practice Address - Street 2:STE 420
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6045
Practice Address - Country:US
Practice Address - Phone:847-635-0117
Practice Address - Fax:847-635-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty